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Hou BQ, Croft AJ, Vaughan WE, Davidson C, Pennings JS, Bowers MF, Vickery JW, Abtahi AM, Gardocki RJ, Lugo-Pico JG, Zuckerman SL, Stephens BF. Racial and Socioeconomic Disparities in Laminoplasty Versus Laminectomy With Fusion in Patients With Cervical Spondylosis. Spine (Phila Pa 1976) 2024; 49:694-700. [PMID: 38655789 DOI: 10.1097/brs.0000000000004793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/26/2023] [Indexed: 04/26/2024]
Abstract
STUDY DESIGN A retrospective cohort study using prospectively collected data. OBJECTIVE The aim of this study was to investigate preoperative differences in racial and socioeconomic factors in patients undergoing laminoplasty (LP) versus laminectomy and fusion (LF) for degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA DCM is prevalent in the United States, requiring surgical intervention to prevent neurological degeneration. While LF is utilized more frequently, LP is an emerging alternative. Previous studies have demonstrated similar neurological outcomes for both procedures. However, treatment selection is primarily at the discretion of the surgeon and may be influenced by social determinants of health that impact surgical outcomes. MATERIALS AND METHODS The Quality Outcome Database (QOD), a national spine registry, was queried for adult patients who underwent either LP or LF for the management of DCM. Covariates associated with socioeconomic status, pain and disability, and demographic and medical history were collected. Multivariate logistic regression was performed to assess patient factors associated with undergoing LP versus LF. RESULTS Of 1673 DCM patients, 157 (9.4%) underwent LP and 1516 (90.6%) underwent LF. A significantly greater proportion of LP patients had private insurance (P<0.001), a greater than high school level education (P<0.001), were employed (P<0.001), and underwent primary surgery (P<0.001). LP patients reported significantly lower baseline neck/arm pain and Neck Disability Index (P<0.001). In the multivariate regression model, lower baseline neck pain [odds ratio (OR)=0.915, P=0.001], identifying as non-Caucasian (OR=2.082, P<0.032), being employed (OR=1.592, P=0.023), and having a greater than high school level education (OR=1.845, P<0.001) were associated with undergoing LP rather than LF. CONCLUSIONS In DCM patients undergoing surgery, factors associated with patients undergoing LP versus LF included lower baseline neck pain, non-Caucasian race, higher education, and employment. While symptomatology may influence the decision to choose LP over LF, there may also be socioeconomic factors at play. The trend of more educated and employed patients undergoing LP warrants further investigation.
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Affiliation(s)
- Brian Q Hou
- Vanderbilt University School of Medicine, Nashville, TN
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew J Croft
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
| | - Wilson E Vaughan
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
| | - Claudia Davidson
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Jacquelyn S Pennings
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Mitchell F Bowers
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Justin W Vickery
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Amir M Abtahi
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Raymond J Gardocki
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Julian G Lugo-Pico
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Scott L Zuckerman
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Byron F Stephens
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
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Cômes PC, Gavotto A, Zouakia Z, Lonjon G, Amelot A, Edgard-Rosa G, Debono B. Repeat Discectomy or Instrumented Surgery for Recurrent Lumbar Disk Herniation: An Overview of French Spine Surgeons' Practice. Global Spine J 2024:21925682241249102. [PMID: 38652921 DOI: 10.1177/21925682241249102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
STUDY DESIGN Retrospective multicenter cohort study. OBJECTIVE Recurrent lumbar disc herniation (ReLDH) is a common condition requiring surgical intervention in a large proportion of cases. Evidence regarding the appropriate choice between repeat microdiscectomy (RD) and instrumented surgery (IS) is lacking. To understand the indications for either of the procedures and compare the results, we aimed to provide an overview of spine surgeon practice in France. METHODS This retrospective, multicenter analysis included adults who underwent surgery for ReLDHs between December 2020 and May 2021. Surgeons were asked which of the following factors determined their therapeutic choice: radio-clinical considerations, non-discal anatomical factors, patient preference, or surgeon background. Data on preoperative clinical status and radiologic findings were collected. Patient-reported outcome measures (PROMs) were assessed and compared using propensity scores preoperatively and at 3 and 12 months postoperatively. RESULTS The study included 150 patients (72 IS and 78 RD). Radioclinical elements, anatomical data, patient preferences, and surgeon background influenced the choice of RD in 57.7%, 1.3%, 25.6%, and 15.4% of the cases, respectively, and IS in 34.7%, 6.9%, 13.9%, and 44.5% of the cases, respectively. At 12 months, patient satisfaction, return to work, and changes in PROMs were not significantly different between the groups. CONCLUSIONS The decision-making process included both objective and subjective factors, resulting in patient satisfaction in 80.3% to 81.5% of cases, with significant clinical improvement in radicular symptoms in 75.8% to 91.8% of cases, and quality of life in 75.8% to 84.9% of cases, depending on the procedure performed.
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Affiliation(s)
- Pierre-Cyril Cômes
- Centre Francilien du Dos, Clinique des Franciscaines, Versailles, France
- Neurosurgical department, Foch Hospital, Suresnes, France
| | - Amandine Gavotto
- University Hospital Nice, Unité de Chirurgie Rachidienne, Nice, France
| | - Zineb Zouakia
- Service de recherche clinique, Hôpital Fondation A. de Rotschild, Paris, France
| | - Guillaume Lonjon
- Department of Orthopedic Surgery, Orthosud, Clinique St-Jean-Sud de France, Santé Cite, Paris, France
| | - Aymeric Amelot
- Département de neurochirurgie, University Hospital of Tours, Tours, France
| | - Grégory Edgard-Rosa
- Centre de Chirurgie Vertébrale (CCV) MONTPELLIER, Clinique du Parc, Castelnau-le-Lez, France
| | - Bertrand Debono
- Centre Francilien du Dos, Clinique des Franciscaines, Versailles, France
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Croft AJ, Pennings JS, Hymel AM, Chanbour H, Khan I, Asher AL, Bydon M, Gardocki RJ, Archer KR, Stephens BF, Zuckerman SL, Abtahi AM. Impact of unplanned readmissions on lumbar surgery outcomes: a national study of 33,447 patients. Spine J 2024; 24:650-661. [PMID: 37984542 DOI: 10.1016/j.spinee.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/22/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND CONTEXT Unplanned readmissions following lumbar spine surgery have immense clinical and financial implications. However, little is known regarding the impact of unplanned readmissions on patient-reported outcomes (PROs) following lumbar spine surgery. PURPOSE To evaluate the impact of unplanned readmissions, including specific readmission reasons, on patient reported outcomes 12 months after lumbar spine surgery. STUDY DESIGN/SETTING A retrospective cohort study of prospectively collected data was conducted using patients included in the lumbar module of the Quality and Outcomes Database (QOD), a national, multicenter spine registry. PATIENT SAMPLE A total of 33,447 patients who underwent elective lumbar spine surgery for degenerative diseases were included. Mean age was 59.8 (SD=14.04), 53.6% were male, 89.5% were white, 45.9% were employed, and 47.5% had private insurance. OUTCOME MEASURES Unplanned 90-day readmissions and 12-month patient-reported outcomes (PROs) including numeric rating scale (NRS) scores for back and leg pain, Oswestry Disability Index (ODI) scores, EuroQol-5 Dimension (EQ-5D) scores, and North American Spine Society (NASS) patient-satisfaction scores. METHODS The lumbar module of the QOD was queried for adults undergoing elective lumbar spine surgery for degenerative disease. Unplanned 90-day readmissions were classified into 4 groups: medical, surgical, pain-only, and no readmissions. Medical and surgical readmissions were further categorized into primary reason for readmission. 12-month PROs assessing patient back and leg pain (NRS), disability (ODI), quality of life (EQ-5D), and patient satisfaction were collected. Multivariable models predicting 12-month PROs were built controlling for covariates. RESULTS A total of 31,430 patients (94%) had no unplanned readmission while 2,017 patients (6%) had an unplanned readmission within 90 days following lumbar surgery. Patients with readmissions had significantly worse 12-month PROs compared with those with no unplanned readmissions in covariate-adjusted models. Using Wald-df as a measure of predictor importance, surgical readmissions were associated with the worst 12-month outcomes, followed by pain-only, then medical readmissions. In separate covariate adjusted models, we found that readmissions for pain, SSI/wound dehiscence, and revisions were among the most important predictors of worse outcomes at 12-months. CONCLUSIONS Unplanned 90-day readmissions were associated with worse pain, disability, quality of life, and greater dissatisfaction at 12-months, with surgical readmissions having the greatest impact, followed by pain-only readmissions, then medical readmissions. Readmissions for pain, SSI/wound dehiscence, and revisions were the most important predictors of worse outcomes. These results may help providers better understand the factors that impact outcomes following lumbar spine surgery and promote improved patient counseling and perioperative management.
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Affiliation(s)
- Andrew J Croft
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA
| | - Alicia M Hymel
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, The Village at Vanderbilt, 1500 21st Ave S Suite 1506, Nashville, TN 37212, USA
| | - Inamullah Khan
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA
| | - Anthony L Asher
- Neuroscience Institute, Atrium Health and Department of Neurosurgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC 28203, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Floor 8, Rochester, MN 55905, USA
| | - Raymond J Gardocki
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA; Department of Physical Medicine & Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, 3401 West End Ave Suite 380, Nashville, TN 37203, USA
| | - Byron F Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, The Village at Vanderbilt, 1500 21st Ave S Suite 1506, Nashville, TN 37212, USA
| | - Scott L Zuckerman
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, The Village at Vanderbilt, 1500 21st Ave S Suite 1506, Nashville, TN 37212, USA
| | - Amir M Abtahi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, The Village at Vanderbilt, 1500 21st Ave S Suite 1506, Nashville, TN 37212, USA.
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Bhandarkar AR, Onyedimma C, Jarrah RM, Ibrahim S, Fu S, Liu H, Bydon M. An Integrated Voice Recognition and Natural Language Processing Platform to Automatically Extract Thoracolumbar Injury Classification Score Features From Radiology Reports. World Neurosurg 2024; 183:e243-e249. [PMID: 38103686 DOI: 10.1016/j.wneu.2023.12.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Many predictive models for estimating clinical outcomes after spine surgery have been reported in the literature. However, implementation of predictive scores in practice is limited by the time-intensive nature of manually abstracting relevant predictors. In this study, we designed natural language processing (NLP) algorithms to automate data abstraction for the thoracolumbar injury classification score (TLICS). METHODS We retrieved the radiology reports of all Mayo Clinic patients with an International Classification of Diseases, 9th or 10th revision, code corresponding to a fracture of the thoracolumbar spine between January 2005 and October 2020. Annotated data were used to train an N-gram NLP model using machine learning methods, including random forest, stepwise linear discriminant analysis, k-nearest neighbors, and penalized logistic regression models. RESULTS A total of 1085 spine radiology reports were included in our analysis. Our dataset included 483 compression, 401 burst, 103 translational/rotational, and 98 distraction fractures. A total of 103 reports had documented an injury of the posterior ligamentous complex. The overall accuracy of the random forest model for fracture morphology feature detection was 76.96% versus 65.90% in the stepwise linear discriminant analysis, 50.69% in the k-nearest neighbors, and 62.67% in the penalized logistic regression. The overall accuracy to detect posterior ligamentous complex integrity was highest in the random forest model at 83.41%. Our random forest model was implemented in the backend of a web application in which users can dictate reports and have TLICS features automatically extracted. CONCLUSIONS We have developed a machine learning NLP model for extracting TLICS features from radiology reports, which we deployed in a web application that can be integrated into clinical practice.
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Affiliation(s)
- Archis R Bhandarkar
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ryan M Jarrah
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sufyan Ibrahim
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunyang Fu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Hongfang Liu
- Digital Health Sciences, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Naik A, Moawad C, Harrop JS, Dhawan S, Cramer SW, Arnold PM. Influence of Body Mass Index on Surgical and Patient Outcomes for Cervical Spine Surgery. Clin Spine Surg 2024; 37:E73-E81. [PMID: 37817307 DOI: 10.1097/bsd.0000000000001531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 08/10/2023] [Indexed: 10/12/2023]
Abstract
STUDY DESIGN Secondary analysis of prospectively collected registry. OBJECTIVE We aim to investigate the effects of body mass index (BMI) on postsurgical cervical spine surgery outcomes and identify a potential substratification of obesity with worse outcomes. SUMMARY OF BACKGROUND DATA The impact of BMI on cervical spine surgery is unknown, with controversial outcomes for patients high and low BMI. METHODS The cervical spine Quality Outcomes Database was queried for a total of 10,381 patients who underwent single-stage cervical spine surgery. Patients were substratified into 6 groups based on BMI. Surgical outcomes, complications, hospitalization outcomes, and patient-reported outcomes for each cohort, including modified Japanese Orthopedic Association Score, Numeric Rating Scale arm pain, Numeric Rating Scale neck pain, Neck Disability Index, and EuroQol Health Survey, were assessed. Univariate analysis was performed for 3- and 12-month follow-up after surgical intervention. RESULTS Obese patients (class I, II, and III) requiring spine surgery were statistically younger than nonobese patients and had higher rates of diabetes compared with normal BMI patients. The surgical length was found to be longer for overweight and all classes of obese patients ( P < 0.01). Class III obese patients had higher odds of postoperative complications. Patients with class II and III obesity had lower odds of achieving optimal modified Japanese Orthopedic Association Score at 3 months [OR = 0.8 (0.67-0.94), P < 0.01, OR = 0.68 (0.56-0.82), P < 0.001, respectively] and 12 months [OR = 0.82 (0.68-0.98), P = 0.03, OR = 0.79 (0.64-0.98), P = 0.03, respectively]. CONCLUSIONS This study investigates the relationship between substratified BMI and postoperative outcomes of cervical spine surgery. Class II and III obese patients have substantially greater risk factors and poor outcomes postoperatively. In addition, low BMI also presents unique challenges for patients. Further research is needed for comprehensive analysis on outcomes of cervical spine surgery after correcting BMI.
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Affiliation(s)
- Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, IL
| | - Christina Moawad
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, IL
| | - James S Harrop
- Department of Neurosurgery, Thomas Jefferson Hospital, Philadelphia, PA
| | - Sanjay Dhawan
- Department of Neurosurgery, University of Minnesota Twin Cities, Minneapolis, MN
| | - Samuel W Cramer
- Department of Neurosurgery, University of Minnesota Twin Cities, Minneapolis, MN
| | - Paul M Arnold
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, IL
- Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL
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Steinle AM, Vaughan WE, Croft AJ, Hymel A, Pennings JS, Chanbour H, Asher A, Gardocki R, Zuckerman SL, Abtahi AM, Stephens BF. Comparing Patient-Reported Outcomes, Complications, Readmissions, and Revisions in Posterior Lumbar Fusion With, Versus Without, an Interbody Device. Spine (Phila Pa 1976) 2024; 49:232-238. [PMID: 37339259 DOI: 10.1097/brs.0000000000004750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/21/2023] [Indexed: 06/22/2023]
Abstract
STUDY DESIGN Retrospective analysis on prospectively collected data. OBJECTIVES To compare posterior lumbar fusions with versus without an interbody in: (1) Patient-reported outcomes (PROs) at 1 year and (2) postoperative complications, readmission, and reoperations. SUMMARY OF BACKGROUND DATA Elective lumbar fusion is commonly used to treat various lumbar pathologies. Two common approaches for open posterior lumbar fusion include posterolateral fusion (PLF) alone without an interbody and with an interbody through techniques, like transforaminal lumbar interbody fusion. Whether fusion with or without an interbody leads to better outcomes remains an area of active research. PATIENTS AND METHODS The Lumbar Module of the Quality Outcomes Database was queried for adults undergoing elective primary posterior lumbar fusion with or without an interbody. Covariates included demographic variables, comorbidities, primary spine diagnosis, operative variables, and baseline PROs, including Oswestry Disability Index, North American Spine Society satisfaction index, numeric rating scale-back/leg pain, and Euroqol 5-dimension. Outcomes included complications, reoperations, readmissions, return to work/activities, and PROs. Propensity score matching and linear regression modeling were used to estimate the average treatment effect on the treated to assess the impact of interbody use on patient outcomes. RESULTS After propensity matching, there were 1044 patients with interbody and 215 patients undergoing PLF. The average treatment effect on the treated analysis showed that having an interbody or not had no significant impact on any outcome of interest, including 30-day complications and reoperations, 3-month readmissions, 12-month return to work, and 12-month PROs. CONCLUSION There were no discernible differences in outcomes between patients undergoing PLF alone versus with an interbody in elective posterior lumbar fusion. These results add to the growing body of evidence that posterior lumbar fusions with and without an interbody seem to have similar outcomes up to 1 year postoperatively when treating degenerative lumbar spine conditions.
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Affiliation(s)
- Anthony M Steinle
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Wilson E Vaughan
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew J Croft
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Alicia Hymel
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jacquelyn S Pennings
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Hani Chanbour
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
| | - Anthony Asher
- Neuroscience Institute, Atrium Health and Department of Neurosurgery, Carolinas Medical Center, Charlotte, North Carolina; Carolina Neurosurgery and Spine Associates, Charlotte, NC
| | - Raymond Gardocki
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Scott L Zuckerman
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
| | - Amir M Abtahi
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
| | - Byron F Stephens
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
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Karsy M, Kshettry V, Gardner P, Chicoine M, Fernandez-Miranda JC, Evans JJ, Barkhoudarian G, Hardesty D, Kim W, Zada G, Crocker T, Torok I, Little A. The RAPID Consortium: A Platform for Clinical and Translational Pituitary Tumor Research. J Neurol Surg B Skull Base 2024; 85:1-8. [PMID: 38274483 PMCID: PMC10807961 DOI: 10.1055/a-1978-9380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Pituitary tumor treatment is hampered by the relative rarity of the disease, absence of a multicenter collaborative platform, and limited translational-clinical research partnerships. Prior studies offer limited insight into the formation of a multicenter consortium. Design The authors describe the establishment of a multicenter research initiative, Registry of Adenomas of the Pituitary and Related Disorders (RAPID), to encourage quality improvement and research, promote scholarship, and apply innovative solutions in outcomes research. Methods The challenges encountered during the formation of other research registries were reviewed with those lessons applied to the development of RAPID. Setting/Participants RAPID was formed by 11 academic U.S. pituitary centers. Results A Steering Committee, bylaws, data coordination center, and leadership team have been established. Clinical modules with standardized data fields for nonfunctioning adenoma, prolactinoma, acromegaly, Cushing's disease, craniopharyngioma, and Rathke's cleft cyst were created using a Health Insurance Portability and Accountability Act-compliant cloud-based platform. Currently, RAPID has received institutional review board approval at all centers, compiled retrospective data and agreements from most centers, and begun prospective data collection at one site. Existing institutional databases are being mapped to one central repository. Conclusion The RAPID consortium has laid the foundation for a multicenter collaboration to facilitate pituitary tumor and surgical research. We sought to share our experiences so that other groups also contemplating this approach may benefit. Future studies may include outcomes benchmarking, clinically annotated biobank tissue, multicenter outcomes studies, prospective intervention studies, translational research, and health economics studies focused on value-based care questions.
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Affiliation(s)
- Michael Karsy
- Department of Neurosurgery, The University of Utah, Salt Lake City, Utah, United States
| | - Varun Kshettry
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, United States
| | - Paul Gardner
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Michael Chicoine
- Department of Neurosurgery, Washington University in Saint Louis, Saint Louis, Missouri, United States
| | - Juan C. Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - James J. Evans
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Garni Barkhoudarian
- Department of Neurosurgery, Pacific Neuroscience Institute, Los Angeles, California, United States
| | - Douglas Hardesty
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Won Kim
- Department of Neurosurgery, University of California, Los Angeles (UCLA), Los Angeles, California, United States
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Los Angeles, California, United States
| | - Tomiko Crocker
- Barrow Clinical Outcomes Center, Barrow Neurological Institute, Phoenix, Arizona, United States
| | - Ildiko Torok
- Barrow Clinical Outcomes Center, Barrow Neurological Institute, Phoenix, Arizona, United States
| | - Andrew Little
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, United States
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Mikkelsen E, Ingebrigtsen T, Thyrhaug AM, Olsen LR, Nygaard ØP, Austevoll I, Brox JI, Hellum C, Kolstad F, Lønne G, Solberg TK. The Norwegian registry for spine surgery (NORspine): cohort profile. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3713-3730. [PMID: 37718341 DOI: 10.1007/s00586-023-07929-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE To review and describe the development, methods and cohort of the lumbosacral part of the Norwegian registry for spine surgery (NORspine). METHODS NORspine was established in 2007. It is government funded, covers all providers and captures consecutive cases undergoing operations for degenerative disorders. Patients' participation is voluntary and requires informed consent. A set of baseline-, process- and outcome-variables (3 and 12 months) recommended by the International Consortium for Health Outcome Measurement is reported by surgeons and patients. The main outcome is the Oswestry disability index (ODI) at 12 months. RESULTS We show satisfactory data quality assessed by completeness, timeliness, accuracy, relevance and comparability. The coverage rate has been 100% since 2016 and the capture rate has increased to 74% in 2021. The cohort consists of 60,647 (47.6% women) cases with mean age 55.7 years, registered during the years 2007 through 2021. The proportions > 70 years and with an American Society of Anaesthesiologists' Physical Classification System (ASA) score > II has increased gradually to 26.1% and 19.3%, respectively. Mean ODI at baseline was 43.0 (standard deviation 17.3). Most cases were operated with decompression for disc herniation (n = 26,557, 43.8%) or spinal stenosis (n = 26,545, 43.8%), and 7417 (12.2%) with additional or primary fusion. The response rate at 12 months follow-up was 71.6%. CONCLUSION NORspine is a well-designed population-based comprehensive national clinical quality registry. The register's methods ensure appropriate data for quality surveillance and improvement, and research.
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Affiliation(s)
- Eirik Mikkelsen
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tor Ingebrigtsen
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway.
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
- The Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway.
| | - Anette M Thyrhaug
- The Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Lena Ringstad Olsen
- Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromsø, Norway
| | - Øystein P Nygaard
- The Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway
- Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway
| | - Ivar Austevoll
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jens Ivar Brox
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christian Hellum
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Frode Kolstad
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Greger Lønne
- Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway
- Department of Orthopaedic Surgery, Innlandet Hospital Trust, Lillehammer, Norway
| | - Tore K Solberg
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- The Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway
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9
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Ayane D, Takele A, Feleke Z, Mesfin T, Mohammed S, Dido A. Low Back Pain and Its Risk Factors Among Nurses Working in East Bale, Bale, and West Arsi Zone Government Hospitals, Oromia Region, South East Ethiopia, 2021 -Multicenter Cross-Sectional Study. J Pain Res 2023; 16:3005-3017. [PMID: 37670738 PMCID: PMC10476655 DOI: 10.2147/jpr.s410803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023] Open
Abstract
Background Hospital nursing staff are particularly susceptible to low back pain (LBP) a widespread health issue worldwide. There was little available data on the prevalence of LBP and risk factors related to it in this population. Objective Assessed the prevalence of LBP and risk factors in nurses working in South-East Ethiopia's Oromia region in the East Bale, Bale, and West Arsi zone government hospitals. Methods A cross-sectional study was carried out within an institution in the East Bale, Bale, and West Arsi zone government hospitals; 440 nurses were chosen to use a process of systematic random sampling, and data was gathered between June 1 and July 30, 2021. Using pre-designed questionnaires, I interrogated participants. After being verified as complete, the gathered data was entered into Epi-data version 3.1 and exported to SPSS version 25 for analysis. Bi variate and multivariate logistic regressions with 95% confidence intervals and crude and adjusted odd ratios were generated and interpreted as necessary. To deem a result statistically significant, a p-value of 0.05 or lower was required. Results A total of 427 nurses engaged in the interview out of the 440 participants that wanted to take part in the study, yielding a response rate of 97.1%. Low back pain was 42.6% more common over a year [95% CI: (0.384, 0.476)]. According to the multivariate analysis, females [AOR = 1.791; 95% CI: (1.121, 2.861)], age higher than forty [AOR=2.388, 95% CI: (1.315, 4.337)], age grouped 31-40 years [(AOR=2.064, 95% CI: 1.233, 3.455)], divorced [(AOR=10.288, 95% CI: (3.063, 34.553)], married [(AOR=1.676 (1.675, 16.999)]. Conclusion The study suggests that implementing preventive measures and offering ergonomic training can help reduce LBP among nurses in these hospitals.
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Affiliation(s)
- Daniel Ayane
- Department of Nursing, School of Health Sciences, Madda Walabu University Goba Referral Hospital, Bale Goba, Oromia, Ethiopia
| | - Abulie Takele
- Department of Medicine, School of Health Sciences, Madda Walabu University Goba Referral Hospital, Bale Goba, Oromia, Ethiopia
| | - Zegeye Feleke
- Department of Nursing, School of Health Sciences, Madda Walabu University Goba Referral Hospital, Bale Goba, Oromia, Ethiopia
| | - Telila Mesfin
- Department of Medicine, School of Health Sciences, Madda Walabu University Goba Referral Hospital, Bale Goba, Oromia, Ethiopia
| | - Salie Mohammed
- Department of Nursing, School of Health Sciences, Madda Walabu University Goba Referral Hospital, Bale Goba, Oromia, Ethiopia
| | - Asnake Dido
- Department of Public Health, Bale Zone Health Office, Bale Goba, Oromia, Ethiopia
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10
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Mummaneni PV, Bydon M. Clinical Databases in Spine Surgery: Strength in Numbers. Neurosurgery 2023; 93:1-3. [PMID: 37318222 DOI: 10.1227/neu.0000000000002465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Affiliation(s)
- Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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11
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Issa TZ, Lee Y, Lambrechts MJ, Reynolds C, Cha R, Kim J, Canseco JA, Vaccaro AR, Kepler CK, Schroeder GD, Hilibrand AS. Publication rates of abstracts presented across 6 major spine specialty conferences. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 14:100227. [PMID: 37266484 PMCID: PMC10230252 DOI: 10.1016/j.xnsj.2023.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 06/03/2023]
Abstract
Background Although scientific researchers aim to present their projects at academic conferences as a step toward publication, not all projects mature to become a peer-reviewed manuscript. The publication rate of meetings can be utilized to assess the quality of presented research. Our objective was to evaluate the contemporary publication rate of abstracts presented at spine conferences. Methods We reviewed annual meeting programs of North American Spine Society (NASS), Scoliosis Research Society (SRS), International Meeting on Advanced Spine Techniques (IMAST), Spine Global Spine Congress (GSC), Lumbar Spine Research Society (LSRS), and Cervical Spine Research Society (CSRS) from 2017 to 2019. Abstracts were identified as published from PubMed and Google search. From published manuscripts, journal name and open access status was collected. Journal impact factors were collected from the 2021 Journal Citation Reports. Results A total of 3,091/5,722 (54%) abstracts were published, ranging from 44.5% to 66.3%. Publication rate of posters and podiums ranged from 39.8% to 64.8% and 51.6% to 67.2%, respectively. Podium presentations were more likely to be published than posters (59.6% vs. 47.2%, p<.001). Only NASS (61.4% vs. 61.8%) and LSRS (64.6% vs. 67.2%) demonstrated similar publication rates for posters and podiums. Award nominated abstracts had a significantly higher publication rate (68.0% vs. 53.4%, p<.001). Among journals with an impact factor, the median overall impact factor was 3.27 and was similar between all conferences except GSC, which was slightly lower (2.72 vs. 3.27, p<.001). Conclusions Fifty-four percent of abstracts were published with 3 societies (NASS, LSRS, and SRS) having rates of over 60%. Moreover, NASS and LSRS demonstrated high publication rates regardless of presentation type. These numbers are significantly higher than previous reports suggesting that these conferences allow attendees to review high quality evidence that is likely to achieve peer-reviewed publication while obtaining an early look at original research.
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Affiliation(s)
- Tariq Z. Issa
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Mark J. Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Christopher Reynolds
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Ryan Cha
- College of Medicine, Drexel University, Philadelphia, PA 19129, United States
| | - James Kim
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
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12
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Wahba AJ, Phillips N, Mathew RK, Hutchinson PJ, Helmy A, Cromwell DA. Benchmarking short-term postoperative mortality across neurosurgery units: is hospital administrative data good enough for risk-adjustment? Acta Neurochir (Wien) 2023:10.1007/s00701-023-05623-5. [PMID: 37243824 DOI: 10.1007/s00701-023-05623-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/02/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Surgical mortality indicators should be risk-adjusted when evaluating the performance of organisations. This study evaluated the performance of risk-adjustment models that used English hospital administrative data for 30-day mortality after neurosurgery. METHODS This retrospective cohort study used Hospital Episode Statistics (HES) data from 1 April 2013 to 31 March 2018. Organisational-level 30-day mortality was calculated for selected subspecialties (neuro-oncology, neurovascular and trauma neurosurgery) and the overall cohort. Risk adjustment models were developed using multivariable logistic regression and incorporated various patient variables: age, sex, admission method, social deprivation, comorbidity and frailty indices. Performance was assessed in terms of discrimination and calibration. RESULTS The cohort included 49,044 patients. Overall, 30-day mortality rate was 4.9%, with unadjusted organisational rates ranging from 3.2 to 9.3%. The variables in the best performing models varied for the subspecialties; for trauma neurosurgery, a model that included deprivation and frailty had the best calibration, while for neuro-oncology a model with these variables plus comorbidity performed best. For neurovascular surgery, a simple model of age, sex and admission method performed best. Levels of discrimination varied for the subspecialties (range: 0.583 for trauma and 0.740 for neurovascular). The models were generally well calibrated. Application of the models to the organisation figures produced an average (median) absolute change in mortality of 0.33% (interquartile range (IQR) 0.15-0.72) for the overall cohort model. Median changes for the subspecialty models were 0.29% (neuro-oncology, IQR 0.15-0.42), 0.40% (neurovascular, IQR 0.24-0.78) and 0.49% (trauma neurosurgery, IQR 0.23-1.68). CONCLUSIONS Reasonable risk-adjustment models for 30-day mortality after neurosurgery procedures were possible using variables from HES, although the models for trauma neurosurgery performed less well. Including a measure of frailty often improved model performance.
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Affiliation(s)
- Adam J Wahba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK.
- Leeds Institute of Medical Research, School of Medicine, Worsley Building, University of Leeds, Leeds, LS2 9JT, UK.
| | - Nick Phillips
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Ryan K Mathew
- Leeds Institute of Medical Research, School of Medicine, Worsley Building, University of Leeds, Leeds, LS2 9JT, UK
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Peter J Hutchinson
- Department of Research, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Adel Helmy
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - David A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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13
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Lambrechts MJ, Brush PL, Lee Y, Issa TZ, Lawall CL, Syal A, Wang J, Mangan JJ, Kaye ID, Canseco JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. Patient-Reported Outcomes Following Anterior and Posterior Surgical Approaches for Multilevel Cervical Myelopathy. Spine (Phila Pa 1976) 2023; 48:526-533. [PMID: 36716386 DOI: 10.1097/brs.0000000000004586] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/11/2023] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare health-related quality of life (HRQoL) outcomes between approach techniques for the treatment of multilevel degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA Both anterior and posterior approaches for the surgical treatment of cervical myelopathy are successful techniques in the treatment of myelopathy. However, the optimal treatment has yet to be determined, especially for multilevel disease, as the different approaches have separate complication profiles and potentially different impacts on HRQoL metrics. MATERIALS AND METHODS Retrospective review of a prospectively managed single institution database of patient-reported outcome measures after 3 and 4-level anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) for DCM. The electronic medical record was reviewed for patient baseline characteristics and surgical outcomes whereas preoperative radiographs were analyzed for baseline cervical lordosis and sagittal balance. Bivariate and multivariate statistical analyses were performed to compare the two groups. RESULTS We identified 153 patients treated by ACDF and 43 patients treated by PCDF. Patients in the ACDF cohort were younger (60.1 ± 9.8 vs . 65.8 ± 6.9 yr; P < 0.001), had a lower overall comorbidity burden (Charlson Comorbidity Index: 2.25 ± 1.61 vs . 3.07 ± 1.64; P = 0.002), and were more likely to have a 3-level fusion (79.7% vs . 30.2%; P < 0.001), myeloradiculopathy (42.5% vs . 23.3%; P = 0.034), and cervical kyphosis (25.7% vs . 7.69%; P = 0.027). Patients undergoing an ACDF had significantly more improvement in their neck disability index after surgery (-14.28 vs . -3.02; P = 0.001), and this relationship was maintained on multivariate analysis with PCDF being independently associated with a worse neck disability index (+8.83; P = 0.025). Patients undergoing an ACDF also experienced more improvement in visual analog score neck pain after surgery (-2.94 vs . -1.47; P = 0.025) by bivariate analysis. CONCLUSIONS Our data suggest that patients undergoing an ACDF or PCDF for multilevel DCM have similar outcomes after surgery.
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Parker L Brush
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Yunsoo Lee
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Tariq Z Issa
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | | | - Amit Syal
- Thomas Jefferson University Medical School, Philadelphia, PA
| | - Jasmine Wang
- Thomas Jefferson University Medical School, Philadelphia, PA
| | - John J Mangan
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Ian David Kaye
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jose A Canseco
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alan S Hilibrand
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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14
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Banashefski B, Stern BZ, Poeran J, Chaudhary SB. Employing journey mapping to improve response rates for patient-reported outcome measures in a spine clinic. Musculoskeletal Care 2023; 21:169-174. [PMID: 35975592 DOI: 10.1002/msc.1682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Bryana Banashefski
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brocha Z Stern
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Institute for Health Care Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jashvant Poeran
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Institute for Health Care Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Saad B Chaudhary
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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15
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Chan AK, Shaffrey CI, Gottfried ON, Park C, Than KD, Bisson EF, Bydon M, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Michalopoulos GD, Sherrod BA, Agarwal N, Chou D, Haid RW, Mummaneni PV. Cervical spondylotic myelopathy with severe axial neck pain: is anterior or posterior approach better? J Neurosurg Spine 2023; 38:42-55. [PMID: 36029264 DOI: 10.3171/2022.6.spine22110] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/23/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether multilevel anterior cervical discectomy and fusion (ACDF) or posterior cervical laminectomy and fusion (PCLF) is superior for patients with cervical spondylotic myelopathy (CSM) and high preoperative neck pain. METHODS This was a retrospective study of prospectively collected data using the Quality Outcomes Database (QOD) CSM module. Patients who received a subaxial fusion of 3 or 4 segments and had a visual analog scale (VAS) neck pain score of 7 or greater at baseline were included. The 3-, 12-, and 24-month outcomes were compared for patients undergoing ACDF with those undergoing PCLF. RESULTS Overall, 1141 patients with CSM were included in the database. Of these, 495 (43.4%) presented with severe neck pain (VAS score > 6). After applying inclusion and exclusion criteria, we compared 65 patients (54.6%) undergoing 3- and 4-level ACDF and 54 patients (45.4%) undergoing 3- and 4-level PCLF. Patients undergoing ACDF had worse Neck Disability Index scores at baseline (52.5 ± 15.9 vs 45.9 ± 16.8, p = 0.03) but similar neck pain (p > 0.05). Otherwise, the groups were well matched for the remaining baseline patient-reported outcomes. The rates of 24-month follow-up for ACDF and PCLF were similar (86.2% and 83.3%, respectively). At the 24-month follow-up, both groups demonstrated mean improvements in all outcomes, including neck pain (p < 0.05). In multivariable analyses, there was no significant difference in the degree of neck pain change, rate of neck pain improvement, rate of pain-free achievement, and rate of reaching minimal clinically important difference (MCID) in neck pain between the two groups (adjusted p > 0.05). However, ACDF was associated with a higher 24-month modified Japanese Orthopaedic Association scale (mJOA) score (β = 1.5 [95% CI 0.5-2.6], adjusted p = 0.01), higher EQ-5D score (β = 0.1 [95% CI 0.01-0.2], adjusted p = 0.04), and higher likelihood for return to baseline activities (OR 1.2 [95% CI 1.1-1.4], adjusted p = 0.002). CONCLUSIONS Severe neck pain is prevalent among patients undergoing surgery for CSM, affecting more than 40% of patients. Both ACDF and PCLF achieved comparable postoperative neck pain improvement 3, 12, and 24 months following 3- or 4-segment surgery for patients with CSM and severe neck pain. However, multilevel ACDF was associated with superior functional status, quality of life, and return to baseline activities at 24 months in multivariable adjusted analyses.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Oren N Gottfried
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Christine Park
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Khoi D Than
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Erica F Bisson
- 2Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Asher
- 4Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 4Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 5Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 6Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 7Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 8Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 8Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | | | - Scott Meyer
- 9Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 10Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag Upadhyaya
- 11Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 12Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 12Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 13Barrow Neurological Institute, Phoenix, Arizona
| | | | - Brandon A Sherrod
- 2Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Nitin Agarwal
- 14Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Dean Chou
- 14Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Regis W Haid
- 15Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Praveen V Mummaneni
- 14Department of Neurological Surgery, University of California, San Francisco, California; and
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16
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Complications, Readmissions, Revisions, and Patient-reported Outcomes in Patients With Parkinson Disease Undergoing Elective Spine Surgery: A Propensity-matched Analysis. Spine (Phila Pa 1976) 2022; 47:1452-1462. [PMID: 35796661 DOI: 10.1097/brs.0000000000004401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/13/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis on prospectively collected data. OBJECTIVE To determine the effectiveness of elective spine surgery in patients with Parkinson disease (PD). BACKGROUND CONTEXT PD has become increasingly prevalent in an aging population. While surgical treatment for degenerative spine pathology is often required in this population, previous literature has provided mixed results regarding its effectiveness. METHODS Data from the Quality Outcomes Database (QOD) was queried between April 2013 and January 2019. Three surgical groups were identified: (1) elective lumbar surgery, (2) elective cervical surgery for myelopathy, (3) elective cervical surgery for radiculopathy. Patients without PD were propensity matched against patients with PD in a 5:1 ratio without replacement based on American Society of Anesthesiology grade, arthrodesis, surgical approach, number of operated levels, age, and baseline Oswestry Disability Index, Numerical Rating Scale (NRS) extremity pain, NRS back pain, and EuroQol 5-Dimensions (EQ-5D). The mean difference was calculated for continuous outcomes (Oswestry Disability Index, NRS leg pain, NRS back pain, and EQ-5D at 3 and 12 mo after surgery) and the risk difference was calculated for binary outcomes (patient satisfaction, complications, readmission, reoperation, and mortality). RESULTS For the lumbar analysis, PD patients had a higher rate of reoperation at 12 months (risk difference=0.057, P =0.015) and lower mean EQ-5D score at 12 months (mean difference=-0.053, P =0.005) when compared with patients without PD. For the cervical myelopathy cohort, PD patients had lower NRS neck pain scores at 3 months (mean difference=-0.829, P =0.005) and lower patient satisfaction at 3 months (risk difference=-0.262, P =0.041) compared with patients without PD. For the cervical radiculopathy cohort, PD patients demonstrated a lower readmission rate at 3 months (risk difference=-0.045, P =0.014) compared with patients without PD. CONCLUSION For the matched analysis, in general, patients with and without PD had similar patient-reported outcomes and complication, readmission, and reoperation rates. These results demonstrate that a diagnosis of PD alone should not represent a major contraindication to elective spine surgery.
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Steinle AM, Fogel JD, Gupta R, Davidson C, Hymel AM, Vaughan WE, Croft AJ, Pennings JS, Archer KR, Zuckerman SL, Gardocki RJ, Abtahi AM, Stephens BF. Assessing the Insurance Deductible Effect on Outcomes After Elective Spinal Surgery. World Neurosurg 2022; 168:e354-e368. [DOI: 10.1016/j.wneu.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/08/2022]
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18
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Mooney J, Michalopoulos GD, Zeitouni D, Sammak SE, Alvi MA, Wang MY, Coric D, Chan AK, Mummaneni PV, Bisson EF, Sherrod B, Haid RW, Knightly JJ, Devin CJ, Pennicooke BH, Asher AL, Bydon M. Outpatient versus inpatient lumbar decompression surgery: a matched noninferiority study investigating clinical and patient-reported outcomes. J Neurosurg Spine 2022; 37:485-497. [PMID: 35523251 DOI: 10.3171/2022.3.spine211558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spine surgery represents an ideal target for healthcare cost reduction efforts, with outpatient surgery resulting in significant cost savings. With an increased focus on value-based healthcare delivery, lumbar decompression surgery has been increasingly performed in the outpatient setting when appropriate. The aim of this study was to compare clinical and patient-reported outcomes following outpatient and inpatient lumbar decompression surgery. METHODS The Quality Outcomes Database (QOD) was queried for patients undergoing elective one- or two-level lumbar decompression (laminectomy or laminotomy with or without discectomy) for degenerative spine disease. Patients were grouped as outpatient if they had a length of stay (LOS) < 24 hours and as inpatient if they stayed in the hospital ≥ 24 hours. Patients with ≥ 72-hour stay were excluded from the comparative analysis to increase baseline comparability between the two groups. To create two highly homogeneous groups, optimal matching was performed at a 1:1 ratio between the two groups on 38 baseline variables, including demographics, comorbidities, symptoms, patient-reported scores, indications, and operative details. Outcomes of interest were readmissions and reoperations at 30 days and 3 months after surgery, overall satisfaction, and decrease in Oswestry Disability Index (ODI), back pain, and leg pain at 3 months after surgery. Satisfaction was defined as a score of 1 or 2 in the North American Spine Society patient satisfaction index. Noninferiority of outpatient compared with inpatient surgery was defined as risk difference of < 1.5% at a one-sided 97.5% confidence interval. RESULTS A total of 18,689 eligible one- and two-level decompression surgeries were identified. The matched study cohorts consisted of 5016 patients in each group. Nonroutine discharge was slightly less common in the outpatient group (0.6% vs 0.3%, p = 0.01). The 30-day readmission rates were 4.4% and 4.3% for the outpatient and inpatient groups, respectively, while the 30-day reoperation rates were 1.4% and 1.5%. The 3-month readmission rates were 6.3% for both groups, and the 3-month reoperation rates were 3.1% for the outpatient cases and 2.9% for the inpatient cases. Overall satisfaction at 3 months was 88.8% for the outpatient group and 88.4% for the inpatient group. Noninferiority of outpatient surgery was documented for readmissions, reoperations, and patient-reported satisfaction from surgery. CONCLUSIONS Outpatient lumbar decompression surgery demonstrated slightly lower nonroutine discharge rates in comparison with inpatient surgery. Noninferiority in clinical outcomes at 30 days and 3 months after surgery was documented for outpatient compared with inpatient decompression surgery. Additionally, outpatient decompression surgery performed noninferiorly to inpatient surgery in achieving patient satisfaction from surgery.
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Affiliation(s)
- James Mooney
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Giorgos D Michalopoulos
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel Zeitouni
- 4School of Medicine, University of North Carolina at Chapel Hill, North Carolina
| | - Sally El Sammak
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohammed Ali Alvi
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael Y Wang
- 5Department of Neurological Surgery, University of Miami, Florida
| | - Domagoj Coric
- 6Neuroscience Institute, Carolinas Healthcare System, and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Andrew K Chan
- 7Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V Mummaneni
- 7Department of Neurological Surgery, University of California, San Francisco, California
| | - Erica F Bisson
- 8Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Brandon Sherrod
- 8Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | | | - John J Knightly
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Clinton J Devin
- 11Steamboat Orthopaedic and Spine Institute, Steamboat Springs, Colorado; and
| | - Brenton H Pennicooke
- 12Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Anthony L Asher
- 6Neuroscience Institute, Carolinas Healthcare System, and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Mohamad Bydon
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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The Collective Influence of Social Determinants of Health on Individuals Who Underwent Lumbar Spine Revision Surgeries: A Retrospective Cohort Study. World Neurosurg 2022; 165:e619-e627. [PMID: 35772707 DOI: 10.1016/j.wneu.2022.06.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To analyze the collective effect of social determinants of health (SDH) on lumbar spine revision surgery outcomes using a retrospective cohort study design. METHODS Data from the Quality Outcomes Database were used, including 7889 adults who received lumbar spine revision surgery and completed 3 and 12 months' follow-up. The SDH of interest included race/ethnicity, educational attainment, employment status, insurance payer, and sex. A stepwise regression model using each number of SDH conditions present (0 of 5, 1 of 5, 2 of 5, ≥3 of 5) was used to assess the collective influence of SDH. The odds of demonstrating a minimum clinically important difference was evaluated in back and leg, disability, quality of life, and patient satisfaction at 3-months and 12-months follow-up. RESULTS An additive effect for SDH was found across all outcome variables at 3 and 12 months. Individuals with ≥3 SDH were at the lowest odds of meeting the minimum clinically important difference of each outcome. At 12 months, individuals with ≥3 SDH had a 67%, 65%, 71%, 65%, and 46% decrease in the odds of a clinically meaningful outcome in back and leg pain, disability, quality of life, and patient satisfaction. CONCLUSIONS Health care teams should evaluate SDH in individuals who may be considered for lumbar spine revision surgery. Viewing social factors in aggregate may be useful as a screening tool for lumbar spine revision surgeries to identify at risk patients who may require pre-emptive care strategies and postoperative resources to mitigate these risks.
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20
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Karamian BA, Mao J, Toci GR, Lambrechts MJ, Canseco JA, Qureshi MA, Silveri O, Minetos PD, Jallo JI, Prasad S, Heller JE, Sharan AD, Harrop JS, Woods BI, Kaye ID, Hilibrand A, Kepler CK, Vaccaro AR, Schroeder GD. Clinical Outcomes at One-year Follow-up for Patients With Surgical Site Infection After Spinal Fusion. Spine (Phila Pa 1976) 2022; 47:1055-1061. [PMID: 35797595 DOI: 10.1097/brs.0000000000004394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/04/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVE To compare health-related quality of life outcomes at one-year follow-up between patients who did and did not develop surgical site infection (SSI) after thoracolumbar spinal fusion. SUMMARY OF BACKGROUND DATA SSI is among the most common healthcare-associated complications. As healthcare systems increasingly emphasize the value of delivered care, there is an increased need to understand the clinical impact of SSIs. MATERIALS AND METHODS A retrospective 3:1 (control:SSI) propensity-matched case-control study was conducted for adult patients who underwent thoracolumbar fusion from March 2014 to January 2020 at a single academic institution. Exclusion criteria included less than 18 years of age, incomplete preoperative and one-year postoperative patient-reported outcome measures, and revision surgery. Continuous and categorical data were compared via independent t tests and χ 2 tests, respectively. Intragroup analysis was performed using paired t tests. Regression analysis for ∆ patient-reported outcome measures (postoperative minus preoperative scores) controlled for demographics. The α was set at 0.05. RESULTS A total of 140 patients (105 control, 35 SSI) were included in final analysis. The infections group had a higher rate of readmission (100% vs. 0.95%, P <0.001) and revision surgery (28.6% vs. 12.4%, P =0.048). Both groups improved significantly in Physical Component Score (control: P =0.013, SSI: P =0.039), Oswestry Disability Index (control: P <0.001, SSI: P =0.001), Visual Analog Scale (VAS) Back (both, P <0.001), and VAS Leg (control: P <0.001, SSI: P =0.030). Only the control group improved in Mental Component Score ( P <0.001 vs. SSI: P =0.228), but history of a SSI did not affect one-year improvement in ∆MCS-12 ( P =0.455) on regression analysis. VAS Leg improved significantly less in the infection group (-1.87 vs. -3.59, P =0.039), which was not significant after regression analysis (β=1.75, P =0.050). CONCLUSION Development of SSI after thoracolumbar fusion resulted in increased revision rates but did not influence patient improvement in one-year pain, functional disability, or physical and mental health status.
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Affiliation(s)
- Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jennifer Mao
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Gregory R Toci
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Mahir A Qureshi
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Olivia Silveri
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Paul D Minetos
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jack I Jallo
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Srinivas Prasad
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Joshua E Heller
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Ashwini D Sharan
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alan Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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21
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Cook CE, George SZ, Asher AL, Bisson EF, Buchholz AL, Bydon M, Chan AK, Haid RW, Mummaneni PV, Park P, Shaffrey CI, Than KD, Tumialan LM, Wang MY, Gottfried ON. High-impact chronic pain transition in surgical recipients with cervical spondylotic myelopathy. J Neurosurg Spine 2022; 37:31-40. [PMID: 35061992 DOI: 10.3171/2021.11.spine211260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE High-impact chronic pain (HICP) is a recently proposed metric that indicates the presence of a severe and troubling pain-related condition. Surgery for cervical spondylotic myelopathy (CSM) is designed to halt disease transition independent of chronic pain status. To date, the prevalence of HICP in individuals with CSM and their HICP transition from presurgery is unexplored. The authors sought to define HICP prevalence, transition, and outcomes in patients with CSM who underwent surgery and identify predictors of these HICP transition groups. METHODS CSM surgical recipients were categorized as HICP at presurgery and 3 months if they exhibited pain that lasted 6-12 months or longer with at least one major activity restriction. HICP transition groups were categorized and evaluated for outcomes. Multivariate multinomial modeling was used to predict HICP transition categorization. RESULTS A majority (56.1%) of individuals exhibited HICP preoperatively; this value declined to 15.9% at 3 months (71.6% reduction). The presence of HICP was also reflective of other self-reported outcomes at 3 and 12 months, as most demonstrated notable improvement. Higher severity in all categories of self-reported outcomes was related to a continued HICP condition at 3 months. Both social and biological factors predicted HICP translation, with social factors being predominant in transitioning to HICP (from none preoperatively). CONCLUSIONS Many individuals who received CSM surgery changed HICP status at 3 months. In a surgical population where decisions are based on disease progression, most of the changed status went from HICP preoperatively to none at 3 months. Both social and biological risk factors predicted HICP transition assignment.
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Affiliation(s)
- Chad E Cook
- 1Department of Orthopaedics, Duke University, Durham, North Carolina
- 2Duke Clinical Research Institute, Duke University, Durham, North Carolina
- 3Department of Population Health Sciences, Durham, North Carolina
| | - Steven Z George
- 1Department of Orthopaedics, Duke University, Durham, North Carolina
- 2Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Anthony L Asher
- 4Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Erica F Bisson
- 5Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Avery L Buchholz
- 6Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Mohamad Bydon
- 7Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew K Chan
- 8Department of Neurological Surgery, University of California, San Francisco, California
| | - Regis W Haid
- 9PPG Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Praveen V Mummaneni
- 8Department of Neurological Surgery, University of California, San Francisco, California
| | - Paul Park
- 10Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Christopher I Shaffrey
- 11Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Khoi D Than
- 11Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | | | - Michael Y Wang
- 13Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Oren N Gottfried
- 11Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
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22
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Rethorn ZD, Cook CE, Park C, Somers T, Mummaneni PV, Chan AK, Pennicooke BH, Bisson EF, Asher AL, Buchholz AL, Bydon M, Alvi MA, Coric D, Foley KT, Fu KM, Knightly JJ, Meyer S, Park P, Potts EA, Shaffrey CI, Shaffrey M, Than KD, Tumialan L, Turner JD, Upadhyaya CD, Wang MY, Gottfried O. Social risk factors predicting outcomes of cervical myelopathy surgery. J Neurosurg Spine 2022; 37:41-48. [PMID: 35090132 DOI: 10.3171/2021.12.spine21874] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 12/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Combinations of certain social risk factors of race, sex, education, socioeconomic status (SES), insurance, education, employment, and one's housing situation have been associated with poorer pain and disability outcomes after lumbar spine surgery. To date, an exploration of such factors in patients with cervical spine surgery has not been conducted. The objective of the current work was to 1) define the social risk phenotypes of individuals who have undergone cervical spine surgery for myelopathy and 2) analyze their predictive capacity toward disability, pain, quality of life, and patient satisfaction-based outcomes. METHODS The Cervical Myelopathy Quality Outcomes Database was queried for the period from January 2016 to December 2018. Race/ethnicity, educational attainment, SES, insurance payer, and employment status were modeled into unique social phenotypes using latent class analyses. Proportions of social groups were analyzed for demonstrating a minimal clinically important difference (MCID) of 30% from baseline for disability, neck and arm pain, quality of life, and patient satisfaction at the 3-month and 1-year follow-ups. RESULTS A total of 730 individuals who had undergone cervical myelopathy surgery were included in the final cohort. Latent class analysis identified 2 subgroups: 1) high risk (non-White race and ethnicity, lower educational attainment, not working, poor insurance, and predominantly lower SES), n = 268, 36.7% (class 1); and 2) low risk (White, employed with good insurance, and higher education and SES), n = 462, 63.3% (class 2). For both 3-month and 1-year outcomes, the high-risk group (class 1) had decreased odds (all p < 0.05) of attaining an MCID score in disability, neck/arm pain, and health-related quality of life. Being in the low-risk group (class 2) resulted in an increased odds of attaining an MCID score in disability, neck/arm pain, and health-related quality of life. Neither group had increased or decreased odds of being satisfied with surgery. CONCLUSIONS Although 2 groups underwent similar surgical approaches, the social phenotype involving non-White race/ethnicity, poor insurance, lower SES, and poor employment did not meet MCIDs for a variety of outcome measures. This finding should prompt surgeons to proactively incorporate socially conscience care pathways within healthcare systems, as well as to optimize community-based resources to improve outcomes and personalize care for populations at social risk.
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Affiliation(s)
- Zachary D Rethorn
- 1Department of Orthopaedics, Duke University, Durham
- 19Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - Chad E Cook
- 1Department of Orthopaedics, Duke University, Durham
- 3Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Christine Park
- 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Tamara Somers
- 3Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Praveen V Mummaneni
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K Chan
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Erica F Bisson
- 6Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Anthony L Asher
- 7Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Avery L Buchholz
- 8Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Mohamad Bydon
- 9Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohammed Ali Alvi
- 9Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Domagoj Coric
- 7Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Kevin T Foley
- 10Department of Neurosurgery, University of Tennessee and Semmes-Murphey Clinic, Memphis, Tennessee
| | - Kai-Ming Fu
- 11Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
| | | | - Scott Meyer
- 12Altair Health Spine and Wellness, Morristown, New Jersey
| | - Paul Park
- 13Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Eric A Potts
- 14Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Christopher I Shaffrey
- 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Mark Shaffrey
- 8Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Khoi D Than
- 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | | | - Jay D Turner
- 16Barrow Neurological Institute, Phoenix, Arizona
| | | | - Michael Y Wang
- 18Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Oren Gottfried
- 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
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An Evolution Gaining Momentum—The Growing Role of Artificial Intelligence in the Diagnosis and Treatment of Spinal Diseases. Diagnostics (Basel) 2022; 12:diagnostics12040836. [PMID: 35453884 PMCID: PMC9025301 DOI: 10.3390/diagnostics12040836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
In recent years, applications using artificial intelligence have been gaining importance in the diagnosis and treatment of spinal diseases. In our review, we describe the basic features of artificial intelligence which are currently applied in the field of spine diagnosis and treatment, and we provide an orientation of the recent technical developments and their applications. Furthermore, we point out the possible limitations and challenges in dealing with such technological advances. Despite the momentary limitations in practical application, artificial intelligence is gaining ground in the field of spine treatment. As an applying physician, it is therefore necessary to engage with it in order to benefit from those advances in the interest of the patient and to prevent these applications being misused by non-medical partners.
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Halicka M, Duarte R, Catherall S, Maden M, Coetsee M, Wilby M, Brown C. Predictors of Pain and Disability Outcomes Following Spinal Surgery for Chronic Low Back and Radicular Pain: A Systematic Review. Clin J Pain 2022; 38:368-380. [PMID: 35413024 DOI: 10.1097/ajp.0000000000001033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Success rates of spinal surgeries to treat chronic back pain are highly variable and useable prognostic indicators are lacking. We aimed to identify and evaluate preoperative predictors of pain and disability after spinal surgery for chronic low back/leg pain. METHODS Electronic database (01/1984-03/2021) and reference searches identified 2622 unique citations. Eligible studies included adults with chronic low back/leg pain lasting ≥3 months undergoing first elective lumbar spine surgery, and outcomes defined as change in pain (primary)/disability (secondary) after ≥3 months. We included 21 reports (6899 participants), 7 were judged to have low and 14 high risks of bias. We performed narrative synthesis and determined the quality of evidence (QoE). RESULTS Better pain outcomes were associated with younger age, higher education, and no spinal stenosis (low QoE); lower preoperative pain, fewer comorbidities, lower pain catastrophizing, anxiety and depression (very low QoE); but not with symptom duration (moderate QoE), other sociodemographic factors (low QoE), disability, or sensory testing (very low QoE). More favorable disability outcomes were associated with preoperative sensory loss (moderate QoE); lower job-related resignation and neuroticism (very low QoE); but not with socioeconomic factors, comorbidities (low QoE), demographics, pain, or pain-related psychological factors (very low QoE). DISCUSSION In conclusion, absence of spinal stenosis potentially predicts greater pain relief and preoperative sensory loss likely predicts reduction in disability. Overall, QoE for most identified associations was low/very low.
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Affiliation(s)
| | - Rui Duarte
- Liverpool Reviews & Implementation Group (LRiG)
| | | | | | | | - Martin Wilby
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Saravi B, Hassel F, Ülkümen S, Zink A, Shavlokhova V, Couillard-Despres S, Boeker M, Obid P, Lang GM. Artificial Intelligence-Driven Prediction Modeling and Decision Making in Spine Surgery Using Hybrid Machine Learning Models. J Pers Med 2022; 12:jpm12040509. [PMID: 35455625 PMCID: PMC9029065 DOI: 10.3390/jpm12040509] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 12/22/2022] Open
Abstract
Healthcare systems worldwide generate vast amounts of data from many different sources. Although of high complexity for a human being, it is essential to determine the patterns and minor variations in the genomic, radiological, laboratory, or clinical data that reliably differentiate phenotypes or allow high predictive accuracy in health-related tasks. Convolutional neural networks (CNN) are increasingly applied to image data for various tasks. Its use for non-imaging data becomes feasible through different modern machine learning techniques, converting non-imaging data into images before inputting them into the CNN model. Considering also that healthcare providers do not solely use one data modality for their decisions, this approach opens the door for multi-input/mixed data models which use a combination of patient information, such as genomic, radiological, and clinical data, to train a hybrid deep learning model. Thus, this reflects the main characteristic of artificial intelligence: simulating natural human behavior. The present review focuses on key advances in machine and deep learning, allowing for multi-perspective pattern recognition across the entire information set of patients in spine surgery. This is the first review of artificial intelligence focusing on hybrid models for deep learning applications in spine surgery, to the best of our knowledge. This is especially interesting as future tools are unlikely to use solely one data modality. The techniques discussed could become important in establishing a new approach to decision-making in spine surgery based on three fundamental pillars: (1) patient-specific, (2) artificial intelligence-driven, (3) integrating multimodal data. The findings reveal promising research that already took place to develop multi-input mixed-data hybrid decision-supporting models. Their implementation in spine surgery may hence be only a matter of time.
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Affiliation(s)
- Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79108 Freiburg, Germany; (S.Ü.); (P.O.); (G.M.L.)
- Department of Spine Surgery, Loretto Hospital, 79100 Freiburg, Germany; (F.H.); (A.Z.)
- Institute of Experimental Neuroregeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria;
- Correspondence:
| | - Frank Hassel
- Department of Spine Surgery, Loretto Hospital, 79100 Freiburg, Germany; (F.H.); (A.Z.)
| | - Sara Ülkümen
- Department of Orthopedics and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79108 Freiburg, Germany; (S.Ü.); (P.O.); (G.M.L.)
- Department of Spine Surgery, Loretto Hospital, 79100 Freiburg, Germany; (F.H.); (A.Z.)
| | - Alisia Zink
- Department of Spine Surgery, Loretto Hospital, 79100 Freiburg, Germany; (F.H.); (A.Z.)
| | - Veronika Shavlokhova
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Sebastien Couillard-Despres
- Institute of Experimental Neuroregeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria;
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Martin Boeker
- Intelligence and Informatics in Medicine, Medical Center Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany;
| | - Peter Obid
- Department of Orthopedics and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79108 Freiburg, Germany; (S.Ü.); (P.O.); (G.M.L.)
| | - Gernot Michael Lang
- Department of Orthopedics and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79108 Freiburg, Germany; (S.Ü.); (P.O.); (G.M.L.)
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Chan AK, Mummaneni PV, Burke JF, Mayer RR, Bisson EF, Rivera J, Pennicooke B, Fu KM, Park P, Bydon M, Glassman SD, Foley KT, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Wang MY, Slotkin JR, Asher AL, Virk MS, Kerezoudis P, Alvi MA, Guan J, Haid RW, Chou D. Does reduction of the Meyerding grade correlate with outcomes in patients undergoing decompression and fusion for grade I degenerative lumbar spondylolisthesis? J Neurosurg Spine 2022; 36:177-184. [PMID: 34534963 DOI: 10.3171/2021.3.spine202059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Reduction of Meyerding grade is often performed during fusion for spondylolisthesis. Although radiographic appearance may improve, correlation with patient-reported outcomes (PROs) is rarely reported. In this study, the authors' aim was to assess the impact of spondylolisthesis reduction on 24-month PRO measures after decompression and fusion surgery for Meyerding grade I degenerative lumbar spondylolisthesis. METHODS The Quality Outcomes Database (QOD) was queried for patients undergoing posterior lumbar fusion for spondylolisthesis with a minimum 24-month follow-up, and quantitative correlation between Meyerding slippage reduction and PROs was performed. Baseline and 24-month PROs, including the Oswestry Disability Index (ODI), EQ-5D, Numeric Rating Scale (NRS)-back pain (NRS-BP), NRS-leg pain (NRS-LP), and satisfaction (North American Spine Society patient satisfaction questionnaire) scores were noted. Multivariable regression models were fitted for 24-month PROs and complications after adjusting for an array of preoperative and surgical variables. Data were analyzed for magnitude of slippage reduction and correlated with PROs. Patients were divided into two groups: < 3 mm reduction and ≥ 3 mm reduction. RESULTS Of 608 patients from 12 participating sites, 206 patients with complete data were identified in the QOD and included in this study. Baseline patient demographics, comorbidities, and clinical characteristics were similarly distributed between the cohorts except for depression, listhesis magnitude, and the proportion with dynamic listhesis (which were accounted for in the multivariable analysis). One hundred four (50.5%) patients underwent lumbar decompression and fusion with slippage reduction ≥ 3 mm (mean 5.19, range 3 to 11), and 102 (49.5%) patients underwent lumbar decompression and fusion with slippage reduction < 3 mm (mean 0.41, range 2 to -2). Patients in both groups (slippage reduction ≥ 3 mm, and slippage reduction < 3 mm) reported significant improvement in all primary patient reported outcomes (all p < 0.001). There was no significant difference with regard to the PROs between patients with or without intraoperative reduction of listhesis on univariate and multivariable analyses (ODI, EQ-5D, NRS-BP, NRS-LP, or satisfaction). There was no significant difference in complications between cohorts. CONCLUSIONS Significant improvement was found in terms of all PROs in patients undergoing decompression and fusion for lumbar spondylolisthesis. There was no correlation with clinical outcomes and magnitude of Meyerding slippage reduction.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - John F Burke
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Rory R Mayer
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Erica F Bisson
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Joshua Rivera
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Brenton Pennicooke
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Kai-Ming Fu
- 3Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Paul Park
- 4Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Mohamad Bydon
- 5Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee, Knoxville, Tennessee
- 8Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Christopher I Shaffrey
- 9Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Eric A Potts
- 10Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Mark E Shaffrey
- 11Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Domagoj Coric
- 12Neuroscience Institute, Carolina Neurosurgery and Spine Associates, Carolinas HealthCare System, Charlotte, North Carolina
| | - John J Knightly
- 13Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Michael Y Wang
- 14Department of Neurological Surgery, University of Miami, Miami, Florida
| | | | - Anthony L Asher
- 12Neuroscience Institute, Carolina Neurosurgery and Spine Associates, Carolinas HealthCare System, Charlotte, North Carolina
| | - Michael S Virk
- 3Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Mohammed A Alvi
- 5Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jian Guan
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Affiliation(s)
- Andrew S Little
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Sherry J Wu
- 2Anderson School of Management, Behavioral Decision Making and Management and Organizations, University of California, Los Angeles, California
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Brusko GD, Basil G, Wang MY. Big Data in the Clinical Neurosciences. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 134:271-276. [PMID: 34862551 DOI: 10.1007/978-3-030-85292-4_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The clinical neurosciences have historically been at the forefront of innovation, often incorporating the newest research methods into practice. This chapter will explore the adoption, implementation, and refinement of big data and predictive modeling using machine learning within neurosurgery. Initial development of national databases arose from surgeons aiming to improve outcome predictions for patients with traumatic brain injury in the 1960s. In the following decades, other surgical specialties began building databases that left a lasting impact on the current national neurosurgical databases, particularly in spine surgery. Significant contributions to the literature have been made as a result of the numerous registries today, leading to broad quality improvements for neurosurgical patients. Important limitations of large databases do exist, including lack of standardized reporting and challenges in data extraction from medical records. New vistas will include the use of metadata to track human function, performance, and pain in a real-time manner to augment the reliance on traditional patient-reported outcome measures (PROMs). Overall, big data has demonstrated significant utility within neurosurgical research and machine learning-powered analyses have highlighted several promising areas of interest for future exploration.
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Affiliation(s)
- G Damian Brusko
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL, USA.
| | - Gregory Basil
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL, USA
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL, USA
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Asuzu DT, Yun JJ, Alvi MA, Chan AK, Upadhyaya CD, Coric D, Potts EA, Bisson EF, Turner JD, Knightly JJ, Fu KM, Foley KT, Tumialan L, Shaffrey M, Bydon M, Mummaneni PV, Park P, Meyer S, Asher AL, Gottfried ON, Than KD, Wang MY, Buchholz AL. Association of ≥ 12 months of delayed surgical treatment for cervical myelopathy with worsened postoperative outcomes: a multicenter analysis of the Quality Outcomes Database. J Neurosurg Spine 2021; 36:568-574. [PMID: 34740180 DOI: 10.3171/2021.7.spine21590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Degenerative cervical myelopathy (DCM) results in significant morbidity. The duration of symptoms prior to surgical intervention may be associated with postoperative surgical outcomes and functional recovery. The authors' objective was to investigate whether delayed surgical treatment for DCM is associated with worsened postoperative outcomes. METHODS Data from 1036 patients across 14 surgical centers in the Quality Outcomes Database were analyzed. Baseline demographic characteristics and findings of preoperative and postoperative symptom evaluations, including duration of symptoms, were assessed. Postoperative functional outcomes were measured using the Neck Disability Index (NDI) and modified Japanese Orthopaedic Association (mJOA) scale. Symptom duration was classified as either less than 12 months or 12 months or greater. Univariable and multivariable regression were used to evaluate for the associations between symptom duration and postoperative outcomes. RESULTS In this study, 513 patients (49.5%) presented with symptom duration < 12 months, and 523 (50.5%) had symptoms for 12 months or longer. Patients with longer symptom duration had higher BMI and higher prevalence of anxiety and diabetes (all p < 0.05). Symptom duration ≥ 12 months was associated with higher average baseline NDI score (41 vs 36, p < 0.01). However, improvements in NDI scores from baseline were not significantly different between groups at 3 months (p = 0.77) or 12 months (p = 0.51). Likewise, the authors found no significant differences between groups in changes in mJOA scores from baseline to 3 months or 12 months (both p > 0.05). CONCLUSIONS Surgical intervention resulted in improved mJOA and NDI scores at 3 months, and this improvement was sustained in both patients with short and longer initial symptom duration. Patients with DCM can still undergo successful surgical management despite delayed presentation.
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Affiliation(s)
- David T Asuzu
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.,2Surgical Neurology Branch, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Jonathan J Yun
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Andrew K Chan
- 5Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | | | - Domagoj Coric
- 7Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 8Goodman Campbell Brain and Spine, Carmel, Indiana
| | - Erica F Bisson
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Jay D Turner
- 9Barrow Neurological Institute, Phoenix, Arizona
| | | | - Kai-Ming Fu
- 11Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
| | - Kevin T Foley
- 12Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | | | - Mark Shaffrey
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Mohamad Bydon
- 3Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Praveen V Mummaneni
- 5Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Paul Park
- 13Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Scott Meyer
- 10Altair Health Spine and Wellness, Morristown, New Jersey
| | - Anthony L Asher
- 7Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Oren N Gottfried
- 14Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina; and
| | - Khoi D Than
- 14Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina; and
| | - Michael Y Wang
- 15Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Avery L Buchholz
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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Karhade AV, Bono CM, Makhni MC, Schwab JH, Sethi RK, Simpson AK, Feeley TW, Porter ME. Value-based health care in spine: where do we go from here? Spine J 2021; 21:1409-1413. [PMID: 33857667 DOI: 10.1016/j.spinee.2021.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Aditya V Karhade
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA; Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Christopher M Bono
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Melvin C Makhni
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rajiv K Sethi
- Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA; Department of Neurosurgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Andrew K Simpson
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas W Feeley
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
| | - Michael E Porter
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
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Vaziri S, Mummaneni PV, Wang MY, Hoh DJ. Brief History of Neurosurgical Spine Societies in the United States: Part 2. Neurospine 2021; 18:257-260. [PMID: 34218608 PMCID: PMC8255776 DOI: 10.14245/ns.2142018.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/12/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sasha Vaziri
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Praveen V Mummaneni
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Michael Y Wang
- Department of Neurosurgery, University of Miami, Miami, FL, USA
| | - Daniel J Hoh
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
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32
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Larkin CJ, Roumeliotis AG, Karras CL, Murthy NK, Karras MF, Tran HM, Yerneni K, Potts MB. Overview of medical malpractice in neurosurgery. Neurosurg Focus 2020; 49:E2. [PMID: 33130621 DOI: 10.3171/2020.8.focus20588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/17/2020] [Indexed: 11/06/2022]
Abstract
Annually, 20% of all practicing neurosurgeons in the United States are faced with medical malpractice litigation. The average indemnity paid in a closed neurosurgical civil claim is $439,146, the highest of all medical specialties. The majority of claims result from dissatisfaction following spinal surgery, although claims after cranial surgery tend to be costlier. On a societal scale, the increasing prevalence of medical malpractice claims is a catalyst for the practice of defensive medicine, resulting in record-level healthcare costs. Outside of the obvious financial strains, malpractice claims have also been linked to professional disenchantment and career changes for afflicted physicians. Unfortunately, neurosurgical residents receive minimal practical education regarding these matters and are often unprepared and vulnerable to these setbacks in the earlier stages of their careers. In this article, the authors aim to provide neurosurgical residents and junior attendings with an introductory guide to the fundamentals of medical malpractice lawsuits and the implications for neurosurgeons as an adjunct to more formal residency education.
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Affiliation(s)
| | | | | | | | - Maria Fay Karras
- 2Pritzker School of Law, Northwestern University, Chicago, Illinois; and
| | - Huy Minh Tran
- 3Department of Neurosurgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
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33
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Zuckerman SL, Devin CJ, Rossi V, Chotai S, Dyer EH, Knightly JJ, Potts EA, Foley KT, Bisson EF, Glassman SD, Mummaneni PV, Bydon M, Asher AL. The Institute for Healthcare Improvement-NeuroPoint Alliance collaboration to decrease length of stay and readmission after lumbar spine fusion: using national registries to design quality improvement protocols. J Neurosurg Spine 2020; 33:812-821. [PMID: 32823267 DOI: 10.3171/2020.5.spine20457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE National databases collect large amounts of clinical information, yet application of these data can be challenging. The authors present the NeuroPoint Alliance and Institute for Healthcare Improvement (NPA-IHI) program as a novel attempt to create a quality improvement (QI) tool informed through registry data to improve the quality of care delivered. Reducing the length of stay (LOS) and readmission after elective lumbar fusion was chosen as the pilot module. METHODS The NPA-IHI program prospectively enrolled patients undergoing elective 1- to 3-level lumbar fusions across 8 institutions. A three-pronged approach was taken that included the following phases: 1) Research Phase, 2) Development Phase, and 3) Implementation Phase. Primary outcomes were LOS and readmission. From January to June 2017, a learning system was created utilizing monthly conference calls, weekly data submission, and continuous refinement of the proposed QI tool. Nonparametric tests were used to assess the impact of the QI intervention. RESULTS The novel QI tool included the following three areas of intervention: 1) preoperative discharge assessment (location, date, and instructions), 2) inpatient changes (LOS rounding checklist, daily huddle, and pain assessments), and 3) postdischarge calls (pain, primary care follow-up, and satisfaction). A total of 209 patients were enrolled, and the most common procedure was a posterior laminectomy/fusion (60.2%). Seven patients (3.3%) were readmitted during the study period. Preoperative discharge planning was completed for 129 patients (61.7%). A shorter median LOS was seen in those with a known preoperative discharge date (67 vs 80 hours, p = 0.018) and clear discharge instructions (71 vs 81 hours, p = 0.030). Patients with a known preoperative discharge plan also reported significantly increased satisfaction (8.0 vs 7.0, p = 0.028), and patients with increased discharge readiness (scale 0-10) also reported higher satisfaction (r = 0.474, p < 0.001). Those receiving postdischarge calls (76%) had a significantly shorter LOS than those without postdischarge calls (75 vs 99 hours, p = 0.020), although no significant relationship was seen between postdischarge calls and readmission (p = 0.342). CONCLUSIONS The NPA-IHI program showed that preoperative discharge planning and postdischarge calls have the potential to reduce LOS and improve satisfaction after elective lumbar fusion. It is our hope that neurosurgical providers can recognize how registries can be used to both develop and implement a QI tool and appreciate the importance of QI implementation as a separate process from data collection/analysis.
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Affiliation(s)
| | - Clinton J Devin
- 2Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- 3Steamboat Orthopaedic and Spine Institute, Steamboat Springs, Colorado
| | - Vincent Rossi
- 4Carolina Neurosurgery & Spine Associates, Neuroscience and Musculoskeletal Institutes, Atrium Health Charlotte, North Carolina
| | | | - E Hunter Dyer
- 4Carolina Neurosurgery & Spine Associates, Neuroscience and Musculoskeletal Institutes, Atrium Health Charlotte, North Carolina
| | | | - Eric A Potts
- 6Goodman Campbell Brain and Spine, University of Indiana, Indianapolis, Indiana
| | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Erica F Bisson
- 8Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Steven D Glassman
- 9Norton Leatherman Spine Center, Norton Healthcare, Louisville, Kentucky
| | - Praveen V Mummaneni
- 10Department of Neurosurgery, University of California, San Francisco, California; and
| | - Mohamad Bydon
- 11Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Asher
- 4Carolina Neurosurgery & Spine Associates, Neuroscience and Musculoskeletal Institutes, Atrium Health Charlotte, North Carolina
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